Efficacy and Safety of Endovenous Laser Ablation in Very Large and Tortuous Great Saphenous Veins

Abstract

PurposeTo investigate the efficacy and safety of endovenous laser ablation (EVLA) with high energy delivery in large great saphenous veins (GSVs) at 1-year sonographic follow-up. Materials and MethodsRetrospective review of 385 patients who underwent EVLA between August 2011 and September 2013 was conducted, and 44 consecutive patients (21 women [47%]; mean age, 41 y; range, 23–66 y) with 49 large GSVs were included. Vein size and clinical follow-up results were recorded. A 600-μm bare-tipped 1,470-nm laser fiber was used for the EVLA procedure. Intended energy delivery was 150 J/cm (10 sessions at 15 W) for proximal GSV segments less than 20 mm in diameter and 195 J/cm (13 sessions at 15 W) for larger veins. Improvements in clinical and quality-of-life scores at 6 months were assessed with three validated scoring systems. ResultsMean GSV diameter was 16.95 mm (range, 15–26 mm). Five patients had GSVs at least 20 mm in diameter. Technical success was observed in 48 GSVs (97.9%) at 1-month follow-up. A second EVLA treatment was performed in one case and achieved closure, for a GSV occlusion rate of 100% at 6 months. All patients showed significant clinical improvement on all three scoring systems (P < .001). One-year follow-up was completed in 48 of 49 cases (98%). No recanalization was observed at 1-year follow-up, and there were no major complications. ConclusionsSonographic follow-up at 1 year shows that EVLA is an effective and safe procedure with excellent technical success rates in the treatment of large GSVs.